Preliminary Consultation Questionnaire

The questionnaire provides me with a basic understanding of your needs. Filling it out does not obligate you to pursue a consultation.

Name *
Name
Have you consulted a physician or other health professional about the issue you'd like to consult with me about? *
Have you received any treatment for this problem? *
If yes, please check the treatments or strategies you've tried: *
Have you had any of the following tests specifically related to this problem? *
Are you taking painkillers? *
Have you used the DVD or Online program, Healing the Hidden Root of Pain? *
If yes, have you worked through all 4 phases of the program at least twice? *
Were any of phases hard to do, hard to understand or hard to follow? *
Have you skipped any of the phases?
If yes, which phases were skipped?
Were any of the phases of the program successful or helpful? Please check: *
Were any of the phases aggravating? *
Do you know or have you ever been told that you have a "pelvic torsion" or that one leg is longer (or shorter) than the other? *
Do you ever experience the feeling that a muscle in your body needs to be stretched but no amount of stretching helps? *

 

If you know you'd like to pursue a consultation, please proceed to the Medical History Form...

 

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